By Graciana Paxton Graciana (she/her) is a first year pre-human biology and society major and plans to minor in public affairs. She lives with her family in Morgan Hill, CA and is fascinated by the intersection of medicine, research, and politics. She is passionate about various social justice issues, specifically those related medicine access in rural areas. Her hobbies include hiking with her dog, going to concerts and the movies (pre-Covid) and trying new food, teas and coffee. In 2010, President Barack Obama signed the Affordable Care Act (often referred to as “Obamacare” or “the ACA”) into law. This expansive legislative healthcare reform is composed of two parts, the Patient Protection and Affordable Care Act and the Health Care Education Reconciliation Act of 2010, and works to increase the number of Americans with health insurance coverage, reduce the high cost of healthcare and health insurance, expand Medicaid at the state level, and implement regulations preventing insurance companies from exploiting and denying individuals coverage. With the passing of the ACA, 20 million Americans gained health insurance. One study even estimates the ACA prevented 19,000 premature deaths. Despite these achievements, support for the ACA has been almost entirely split along party lines since its initial passing where no Republican senators voted in favor of the bill.
Republicans have been consistent and relentless in their attempts to delegitimize and deconstruct the ACA. According to a 2017 Newsweek report, since its initial passing, there have been 70 attempts from Republicans to either alter or repeal the law. Despite these failed legislative attacks, the ACA and in turn millions of Americans insured by it remain at risk, as when these legislative reforms are paired with legal challenges they have the potential to truly alter this law. On November 10, the Supreme Court began hearing oral arguments in California v. Texas, a case regarding the constitutionality of the Affordable Care Act (ACA) and the most recent of many legal challenges to Obamacare. To understand the basis of the California v. Texas as well its potential implications for individuals benefiting from the ACA, one must first look to the history of challenges to ACA’s constitutionality over the law's decade long life. Republican state governments specifically have been relentless in their attempts to sever portions of the law with hopes of dissolving the act entirely. Although several elements of the ACA have faced legal challenges, the focus of the majority of these lawsuits is Section 5000A, which explains the law’s “individual mandate.” The individual mandate of the ACA requires that the majority of Americans have some form of qualifying health insurance by 2014, with a refusal to do so leading to a monetary penalty often referred to as “the shared responsibility payment.” In the 2012 case of National Federation of Independent Business v. Sebelius, the Supreme Court made decisions on several challenges to the ACA, most notably the argument from 26 states that the individual mandate is unconstitutional as the federal government cannot penalize individuals for their refusal to purchase a “commercial product.” The court ruled in favor of the individual mandate’s constitutionality in a 5-4 decision where conservative leaning Chief Justice Roberts sided with liberal Justices Ginsburg, Kagan, Sotomayer, and Breyer. They argued the individual mandate's constitutionality lies in the taxing and spending powers of Congress, as outlined in the Constitution, as the mandate's penalty is most accurately characterized as a tax. In 2017, the Tax Cuts and Jobs Act (TCJA) was passed under the Trump Administration, which eliminated the monetary penalty by setting the shared responsibility payment as zero dollars which essentially repeals the individual mandate. Several states have created their own individual mandates and associated monetary penalties to continue to uphold this element of the ACA in their states. Despite these state mandates, now that there is no tax at the federal level associated with the individual mandate, the previous definition of the constitutionality of the mandate and ACA as a whole from the Supreme Court in 2012, has become more vulnerable than ever. This lack of constitutionality clarity created by the TCJA, is the basis for the current ongoing case of California v. Texas. 20 states joined together in 2018 (due to shifts in the leading political party in some state legislatures, this number has since been reduced to 18 states), to file a lawsuit intending to strike down the ACA as a whole. Led by Texas, these states argued that assuming the individual mandate is now unconstitutional the entire law is also unconstitutional and must be dissolved. Furthermore, the Texas Attorney General provided a briefing explaining these claims saying “Congress meant for the individual mandate to be the centerpiece of Obamacare. Without the constitutional justification for the centerpiece, the law must go down,” even going as far as labeling the ACA as “a failed social experiment.” 17 states have intervened in the case as defendants of the ACA and are led by California. This case was taken to the 5th Circuit Court of appeals, where the court’s decision ruled that the individual mandate is unconstitutional, but did not come to a decision on whether this means the entire ACA is to be struck down, sending the case back to lower courts. After the states acting as defendants of ACA, petitioned the Supreme Court, arguing that the decisions for this case in lower courts were done “in a way that creates uncertainty about the status of the entire Affordable Care Act" and that this case requires review from a higher federal level. In March 2020, the Supreme Court agreed to hear the case and oral arguments took place November 10th, 2020. The court heard oral arguments in favor of upholding the ACA from representatives of the California side of the case, as well as arguments from the U.S. House of Representatives, and against the law from representatives from the Texas side of the case, and the Trump Administration. Although the ACA survived its previous court challenge with a 5-4 conservative leaning court, this was in large part due to the power of Chief Justice Roberts to act as swing vote and the labeling of the individual mandate as tax. Now the question remains if the ACA can survive the current court’s 6-3 conservative majority with the passing of Justice Ginsburg and nomination of Justice Barrett, who previously argued in opposition of the constitutionality of Obamacare. Even if Chief Justice Roberts sides with the liberal justices on the court almost certain to rule in favor of upholding the ACA, one more conservative justice will need to break from party lines to support the law due to the new ideological makeup of the court. If the Court ultimately decides that with the unconstitutionality of the individual mandate, the entire law must be struck down, this would affect the majority of Americans in some way and be detrimental to millions due to the expansiveness of the ACA. Regardless of the decision in this case, the incoming Biden-Harris administration remains staunchly committed to guaranteeing the preservation of the ACA, with a detailed plan to expand and build upon Obamacare to serve more individuals as well as make the law less vulnerable to legal attacks. This means that even if the law is overturned through California v. Texas, President-elect Biden will seek routes to reinstate it likely through executive order. However, the effects of millions of Americans losing their health insurance for several months, specifically during a pandemic will still be catastrophic even with this back-up plan to save the ACA. Decreasing the number of insured Americans and access to medicare and medicaid, allowing for health programs to discriminate against individuals based on race, gender, national origin, sexual orientation, age, amd ability, removing those under age 26 from their parents health insurance, and eliminating protections preventing the denial of coverage for with pre-existing conditions, are just a few of many devastating consequences that come with the repeal of the ACA and this is gravely concerning. With the ushering in of a new administration, January 20th, 2021 is a “beautiful day to save lives.”
1 Comment
Todd Colleen
11/25/2020 02:24:34 pm
Very well said!
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